Methods and systems for detecting possible error in patient position

ABSTRACT

Systems and methods for automatically and dynamically modifying an image acquisition parameter for use in tomosynthesis breast imaging. A selected image acquisition parameter is modified in response to a measured characteristic of an imaged object such as a breast, and thus tailored to provide the highest quality image for the particular object. For example, image quality in a breast tomosynthesis system can be improved by dynamically varying motion and other acquisition parameters of the tomosynthesis system in response to physical characteristics of the breast to be imaged (determined during image acquisition), such as the breast thickness, density or composition. Dynamically varying acquisition or processing methods helps to customize the system for each particular patient, thereby improving image quality and identification and assessment of potential pathologies and abnormalities, and lower radiation dose, and thus a reduced the risk of long-term adverse health effects due to lifetime accumulated radiation dose.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority under 35 U.S.C. §119 from provisionalU.S. patent application Ser. No. 61/381,438, filed Sep. 9, 2010, thecontents of which are incorporated herein by reference as thought setforth in full.

FIELD OF THE INVENTION

Embodiments of the invention relate to medical imaging, and moreparticularly, to acquisition and analysis of medical images.

BACKGROUND

Millions of people have suffered from breast cancer and other types ofcancer. It is estimated that in the United States, breast cancermortality is second only to that of lung cancer. Because of its role inearly tumor detection, mammography has become the most commonly usedtool for breast cancer screening, diagnosis and evaluation in the UnitedStates. A mammogram is an x-ray image of inner breast tissue that isused to visualize normal and abnormal structures within the breasts. Acommon purpose of breast imaging is to identify and assess potentialpathologies or other abnormalities, which most frequently appear aslikely micro-calcifications, tumor masses and architectural distortions.Mammograms provide early cancer detection because they can often showbreast lumps and/or calcifications before they are manually palpable.

While screening mammography is recognized as the most effective methodfor early detection of breast cancer, the modality has limitations. Oneproblem with known mammogram systems and methods lies in their lowspecificity. More particularly, it is often difficult to determinewhether a detected abnormality is associated with a cancerous or benignlesion. This difficulty arises from the fact that a mammogram is twodimensional (2D) representations of a three dimensional (3D) structure,and overlapping structures in the compressed breast may confounddiagnosis. These difficulties are further complicated in view ofdifferent breast compositions.

For example, breast composition, including breast x-ray density andtexture, can vary from one patient to another, from one breast toanother of the same patient and even within a single breast. Somebreasts are composed mainly of fatty tissue and are known as “fattybreasts,” while others have a high percentage of fibro glandular tissueand are known as “dense breasts.” Most breast compositions are somewherein between.

Efforts to improve the sensitivity and specificity of breast x-rays haveincluded the development of breast tomosynthesis systems. Breasttomosynthesis is a 3D imaging technology that involves acquiring imagesof a stationary compressed breast at multiple angles during a shortscan. The individual images are then reconstructed into a series ofthin, high-resolution slices that can be displayed individually or in adynamic cinémode. Reconstructed tomosynthesis slices reduce or eliminatethe problems caused by tissue overlap and structure noise in singleslice 2D mammography imaging. Digital breast tomosynthesis also offersthe possibility of reduced breast compression, improved diagnostic andscreening accuracy, fewer recalls, and 3D lesion localization. Examplesof breast tomosynthesis systems are described in U.S. Pat. Nos.7,245,694 and 7,123,684, commonly owned by the Assignee of thisapplication, the contents of which are incorporated herein by reference.

One goal of any x-ray imaging system is to obtain the highest qualityimage while minimizing the patient dose. Tomosynthesis acquisitionsystems balance the two goals by identifying a scanning protocol thatobtains sufficient data to generate a quality reconstruction. Thescanning protocol defines the number of images obtain during a scan, theangular range of the scan and the duration of the exposures. Forexample, a current tomosynthesis product is designed to perform a sweepangle of 15 degrees in about 5 seconds, during which 15 projections areacquired. The scanning protocol is generally fixed and used on allbreast sizes and compositions.

While certain 2-D mammography systems have been introduced that vary,for example, the exposure time based on a measured thickness of thebreast (determined by a distance between compression paddles), ingeneral breast imaging systems lack the capability of customizing imageacquisition parameters according to one or more of the preferredembodiments described herein.

SUMMARY

Embodiments are generally directed to obtaining the highest qualityimages can be obtained by tailoring the operating parameters of theimage acquisition device used to acquire the image according to theparticular composition of the individual breast. For example, accordingto embodiments, it is realized that tomosynthesis image quality may beimproved by dynamically varying image acquisition parameters based onthe physical characteristics of the imaged object. According to oneembodiment, in a breast x-ray tomosynthesis imaging system, prior toacquiring a plurality of tomosynthesis projection images at a respectiveplurality of gantry angles encompassing a tomosynthesis imaging arc, aninitial or scout image of the breast is acquired by the tomosynthesisimaging system, the scout image comprising a 2D projection imageacquired at a gantry angle, the scout image being acquired such that agenerally low dose of x-ray radiation is applied, e.g., comparable to orless than the radiation dose associated with one of the tomosynthesisprojection images. The scout image is then automatically processed tocompute one or more measured characteristics of the breast, and the oneor more measured characteristics are used to automatically determine aset of tomosynthesis image acquisition parameters, or operatingparameters, that are tailored for that breast.

For example, one embodiment is directed to a method for acquiring aplurality of images of breast tissue during a scan of the breast tissueby an image acquisition device and comprises acquiring a first image ofthe breast tissue using the image acquisition device and processing thefirst image to determine a physical characteristic of the breast tissue.The method further comprises deriving or modifying at least oneoperating parameter of the image acquisition device based at least inpart upon the physical characteristic. The modified operatingparameter(s) include a motion parameter of the image acquisition device.The method further comprises acquiring a plurality of projection imagesof the breast tissue using the image acquisition device and the at leastone motion parameter. Further, according to another embodiment, acomparison involves a view from a present study with a view from a priorstudy, and in such embodiments in which the comparison is temporal, thenthe current value may be larger than the prior. In such cases, thepositioning may be better that that of the prior such that more tissueis pulled into view onto a detector. However, if the value for thecurrent is smaller than that of the prior, then the positioning may beworse such that less tissue is pulled onto the detector.

Another embodiment is directed to a computer-implemented method foracquiring a plurality of images of breast tissue during a scan of thebreast tissue and that is performed or executed by an image acquisitiondevice or system (or by one or more controllers, processors or othercomputer components thereof). The computer-implemented method comprisesthe image acquisition device acquiring a first image of the breasttissue, processing or analyzing first image data to determine or assessa selected or pre-determined physical characteristic of the breasttissue, and deriving or modifying at least one operating parameter thatwas previously utilized during acquisition of the first image based atleast in part upon the physical characteristic. The modified operatingparameter(s) include at least one modified motion parameter of the imageacquisition device. The method further comprises acquiring a pluralityof projection images of the breast tissue using the at least one motionparameter.

Yet another embodiment is directed to utilizing a 2D projection image todetermine whether to proceed with additional 3D projection images. Inone embodiment, a computer-implemented method for acquiring a pluralityof images of breast tissue during a scan of the breast tissue by animage acquisition device comprises an image acquisition device (orcontroller, processor or computer thereof) acquiring a 2D projectionimage of the breast tissue, processing the 2D projection image todetermine a physical characteristic of the breast tissue, determiningwhether a plurality of 3D projection images of the breast issue shouldbe acquired based at least in part upon the physical characteristic, andacquiring the plurality of 3D projection images if it is determined thatthe physical characteristic satisfies pre-determined criteria such as athreshold value.

A further embodiment is directed to a computer-implemented method foracquiring a plurality of images of breast tissue during a scan of thebreast tissue by an image acquisition device and comprises utilizing a3D projection image to determine whether to proceed with additional 2Dprojection images. In one embodiment, a computer-implemented method foracquiring a plurality of images of breast tissue during a scan of thebreast tissue by an image acquisition device comprises an imageacquisition device (or controller, processor or computer thereof)acquiring a 3D projection image of the breast tissue, processing the 3Dprojection image to determine a physical characteristic of the breasttissue, determining whether a plurality of 2D projection images of thebreast issue should be acquired based at least in part upon the physicalcharacteristic, and acquiring the plurality of 2D projection images ifit is determined that the physical characteristic satisfiespre-determined criteria such as a threshold value.

Yet another embodiment is directed to a method for detecting a possiblepatient positioning error during x-ray breast image acquisition of thesame breast.

One embodiment involves positioning, under the control of a technicianor user of an image acquisition device, a breast of a patient into afirst compressed imaging position according to a first view of the imageacquisition device and acquiring a first mammographic image of thebreast in the first compressed imaging position. The method furthercomprises positioning, under the control of the technician or user, thebreast into a second compressed imaging position according to a secondview of the image acquisition device and acquiring a second mammographicimage of the breast in the second compressed imaging position. Themethod further comprises processing the first and second mammographicimages to compute, for each of the mammographic images, at least onebreast volume assessment metric and comparing the at least one breastvolume assessment metric for the first mammographic image to the atleast one breast volume assessment metric for the second mammographicimage. If the breast volume assessment metrics differ by more than athreshold amount, then at least one user interface device associatedwith the image acquisition device is activated to alert the technicianor user of a possible breast positioning error based at least in partupon the difference.

According to certain embodiments, methods for detecting a possiblepatient position error are computer-implemented, e.g., performed by animage acquisition device or controller, processor or computer thereof,such that the image acquisition device acquires a first mammographicimage of a breast in a first compressed imaging position according to afirst view, wherein the breast was positioned by a user of the imageacquisition device into the first compressed imaging position accordingto the first view, and acquires a second mammographic image of thebreast in a second compressed imaging position according to a secondview, wherein the breast was positioned by the user into the secondcompressed imaging position according to the second view. The imageacquisition device processes the first and second mammographic images tocompute, for each of the first and second mammographic images, at leastone breast volume assessment metric and compares the at least one breastvolume assessment metric for the first mammographic image to the atleast one breast volume assessment metric for the second mammographicimage. If the breast volume assessment metrics differ by more than athreshold amount, the image acquisition device activates at least oneuser interface device associated with the image acquisition device thatalerts the user of a possible breast positioning error based at least inpart upon the difference.

Yet another embodiment is directed to a computer-implemented method foracquiring a plurality of images of breast tissue during a scan of thebreast tissue by a computer-controlled image acquisition device andcomprises acquiring a first image of the breast tissue using a firstimaging modality and a first image acquisition device and processing thefirst image to determine a physical characteristic of the breast tissue.The method further comprises determining that a plurality of projectionimages should be acquired using one or both of a second imaging modalitydifferent than the first imaging modality and a second image acquisitiondevice different than the first image acquisition device. The methodfurther comprises notifying an operator of the first image acquisitiondevice that a plurality of additional images should be acquired using atleast one of the second imaging modality and the second imageacquisition device. Thus, for example, the operator may be notified thatthe plurality of additional images should be acquired using the secondimaging modality and the first image acquisition device or that theplurality of additional images should be acquired using the secondimaging modality and the second image acquisition device.

A further embodiment is directed to a method for detecting a possiblepatient positioning error during x-ray breast image acquisition ofdifferent patient breasts, which may involve the same or different viewsof different breasts.

One embodiment involves positioning, under the control of user of animage acquisition device, a first breast of a patient into a firstcompressed imaging position according to a first view of the imageacquisition device, acquiring a first mammographic image of the firstbreast in the first compressed imaging position, positioning, under thecontrol of the user, a second breast of the patient into a secondcompressed imaging position according to a second view of the imageacquisition device, the second breast being opposite the first breast,and acquiring a second mammographic image of the second breast in thesecond compressed imaging position. The method further comprisesprocessing the first and second mammographic images to compute, for eachof the first and second mammographic images, at least one breast volumeassessment metric and comparing the at least one breast volumeassessment metric for the first mammographic image to the at least onebreast volume assessment metric for the second mammographic image. Ifthe breast volume assessment metrics differ by more than a thresholdamount, activating at least one user interface device associated withthe image acquisition device that alerts the user of a possible breastpositioning error based at least in part upon the difference.

Another embodiment is directed to a computer-implemented method fordetecting a possible patient positioning error during x-ray breast imageacquisition, the method comprising and involves an image acquisitiondevice (or controller, processor or computer thereof) acquiring a firstmammographic image of a first breast in a first compressed imagingposition and acquiring a second mammographic image of the second breastin a second compressed imaging position according to a second view. Theimage acquisition device processes the first and second mammographicimages to compute, for each of the first and second mammographic images,at least one breast volume assessment metric, and then compares the atleast one breast volume assessment metric for the first mammographicimage to the at least one breast volume assessment metric for the secondmammographic image. If the breast volume assessment metrics differ bymore than a threshold amount, activating at least one user interfacedevice associated with the image acquisition device that alerts the userof a possible breast positioning error based at least in part upon thedifference.

Embodiments related to detecting possible position errors may involve abreast volume assessment metric involving at least one of a total breastvolume (Vb), a fibroglandular tissue volume (Vfg), and a ratio (Vfg/Vb)of fibroglandular tissue volume to total breast volume and the same ordifferent views such as one or both of a craniocaudal (CC) view and thesecond view is a mediolateral oblique (MLO) view. For example,embodiments may involve comparison of different views of the samebreast, the same views of different breasts, or different views ofdifferent breasts.

Further embodiments are directed to systems that are programmed,configured or operable to implement method embodiments, under technicianor user control and/or automatically, and to acquire breast imagesand/or detect possible patient positioning errors.

For example, one embodiment is directed to a system for acquiring aplurality of images of breast tissue during a scan of the breast tissuethat comprises a gantry, an image acquisition device, a controller, adetector and a processor. The gantry supports the image acquisitiondevice, and the controller is coupled to the gantry for controlling amotion parameter of the image acquisition device during an imageacquisition. The detector generates at least one image of the object inresponse to an output of the image acquisition device received at thedetector. The processor is in communication with the controller and thedetector and is configured to acquire a first image of the breast tissuegenerated by the detector. The processor is configured to analyze thefirst image to identify at least one physical characteristic of thebreast and to provide data related to the physical characteristic to thecontroller, which is configured to dynamically modify a selected orpre-determined motion parameter of the image acquisition device that waspreviously utilized during acquisition of the first image based at leastin part upon the physical characteristic data for use in acquiring aplurality of projection images of the breast tissue with the modifiedmotion parameter.

As yet other examples, other system embodiments are directed todetecting possible patient positioning errors and utilizing a 2Dprojection image to determine whether to proceed with additional 3Dprojection images.

Further embodiments are directed to computer program products orarticles of manufacture comprising a non-transitory computer readablestorage medium embodying one or more instructions executable by acomputer to perform one or more processes to implement embodiments suchas a process for acquiring a plurality of images of breast tissue duringa scan of the breast tissue by an image acquisition device, acquiring a2D projection image to determine whether to acquire multiple 3Dprojection images and which imaging modality to utilize, and/ordetecting a possible patient positioning error.

In a single or multiple embodiments, one particularly advantageous setof measured breast tissue characteristics to use in selecting imageacquisition parameters such as a motion parameter includes one or morebreast density characteristics derived from a computed physicaldescription of the breast tissue. In a single or multiple embodiments,the breast density characteristics can be processed on a localized,regional, and/or breast-wide basis, and the results used to select anoptimal set of tomosynthesis image acquisition parameters. In a singleor multiple embodiments, the tomosynthesis image acquisition parametersthat are tailored to or customized for the measured breastcharacteristics include the extent of the tomosynthesis imaging arc, thenumber of projection images, the gantry angular velocity or overallgantry sweep time, and/or per-projection-image exposure time window(exposure window) to provide one or more of improved image quality andreduced imaging dose. The ability to dynamically vary acquisition orprocessing methods provides for patient and breast customization,thereby providing one or more of (i) improved image quality, and thus animproved ability to identify and assess potential pathologies andabnormalities, and (ii) lower radiation dose, and thus a reduced therisk of long-term adverse health effects due to lifetime accumulatedradiation exposure. In a single or multiple embodiments, breastcomposition characteristics are considered, e.g., not only breastdensity but also breast tissue parenchymal pattern or distribution.

In a single or multiple embodiments, one or more automatic volumeassessments of the breast are computed from the scout image informationand processed to detect potential errors in patient positioning. Basedon the general principle that measured total breast volume (Vb),measured total breast fibroglandular tissue volume (Vfg), and/or theratio Vb/Vfg should stay generally the same between two image views suchas the CC and MLO views, these metrics are computed for each of thedifferent views and the results are compared. If one or more of themetrics is substantially different between views, then this fact isbrought to the attention of the technician, such as by an alarm or othermechanism, to denote that there may have been a positioning error in oneor both of the views. In still other single or multiple embodiments,similar comparisons can be performed in a contralateral context (i.e.,left breast versus right breast) and substantial discrepancies broughtto the attention of the technician for similar quality assurancepurposes.

In a single or multiple embodiments, the first image and the pluralityof projection images are acquired with the same image acquisitiondevice, which may be a single or multi-modality image acquisition deviceor an acquisition device that can acquire different types of images orusing different imaging methods. In this manner, the first or scoutimage and the plurality of other projection images may be acquired withthe same imaging device, different imaging devices, and using the sameor different imaging modalities. For this purpose, the image acquisitiondevice may be operable to use different imaging modalities and mayautomatically switch to a different imaging modality or recommend to theuser or technician that another imaging modality or imaging deviceshould be utilized, if it is determined that other images are to beacquired. According to one embodiment, the first image and the pluralityof projection images are acquired with an x-ray imaging device such as atomosynthesis x-ray imaging device. According to another embodiment, thefirst image is acquired with a tomosynthesis x-ray imaging device, andthat first image is used to determine or recommend what other imagingprocedure to execute.

In a single or multiple embodiments, one or multiple motion parameterssuch as sweep angle or sweep speed are modified dynamically during ascan of a particular patient in real-time. Other parameters may also bemodified including an exposure parameter such as one or more of anexposure window, an exposure voltage or and an exposure number. Thus,the first or scout image is not a calibration image and instead is animage acquired during a scan of the same patient.

In a single or multiple embodiments, the first image that is acquireduses a low dose x-ray, e.g., lower than a normal mammogram exposure. Forexample, the first radiation dose used to generate the first image canbe expressed as Df=Dp*1/(1+N), wherein Df=the first radiation dose, Dp=atotal radiation dose of the plurality of projection images, and N=anumber of the plurality of projection images. Thus, in this embodiment,the first image dose may be substantially smaller than the subsequentimages individually and/or collectively. For example, the first imagedose may be substantially less than a radiation dose used to generate atomosynthesis total scan or standard 2D mammography exposure.

In a single or multiple embodiments, the physical characteristic of thebreast tissue that is processed or analyzed is the density or thicknessof the breast tissue. The image acquisition device (or processor,controller or computer thereof or associated therewith) determines thedensity based at least in part upon a physical description of the breasttissue expressed as Vfg, Vb and Vfg/Vb, wherein Vfg=a volume offibroglandular the breast tissue, and Vb=a volume of the breast tissue.With this data, in certain embodiments, a controller can look up densitydata within a table or other resource to identify at least one imagingmodality (which may be the same or different than the imaging modalityused to acquire the first image that was analyzed) based on whether thedensity data satisfies pre-determined criteria or a threshold value. Forexample, the table may include data that associates different imagingmodalities with their respective density data such that the system canautomatically proceed with or recommend the other imaging modalities,which may be supported by the same or different image acquisitiondevice.

Additional inventions that are disclosed and described herein include,but are not limited to:

A computer-implemented method for acquiring a plurality of images ofbreast tissue during a scan of the breast tissue by an image acquisitiondevice, the method comprising: a computer-controlled image acquisitiondevice acquiring a first image of the breast tissue; the imageacquisition device processing the first image to determine a physicalcharacteristic of the breast tissue; the image acquisition devicemodifying at least one operating parameter that was previously utilizedduring acquisition of the first image based at least in part upon thephysical characteristic, the at least one modified operating parametercomprising a motion parameter of the image acquisition device; and theimage acquisition device acquiring a plurality of projection images ofthe breast tissue using the modified motion parameter.

The image acquisition device determining whether a plurality ofadditional images of the breast issue should be acquired; and the imageacquisition device acquiring the plurality of other images if it isdetermined that the plurality of other images should be acquired.

The first image and the plurality of projection images being acquiredwith an image acquisition device comprising a multi-modality imageacquisition device.

The image acquisition device determining whether a plurality ofadditional images of the breast issue should be acquired; and the imageacquisition device identifying at least one imaging modality of aplurality of imaging modalities and acquiring the plurality of otherimages using the at least one identified imaging modality if it isdetermined that the plurality of other images should be acquired.

The first image and the plurality of projection images being acquiredwith a computer-controlled image acquisition device comprising an x-rayimaging device.

The first image and the plurality of projection images being acquiredwith the image acquisition device comprising a tomosynthesis x-rayimaging device.

The first image being acquired using a first imaging modality, and theplurality of additional images being acquired using a second imagingmodality that is different than the first imaging modality.

The first image comprising a two dimensional projection image of thebreast tissue, and the plurality of additional images comprising threedimensional projection images of the breast tissue.

The image acquisition device determining that the second imagingmodality should be utilized to acquire the plurality of additionalimages based at least in part upon the physical characteristic of thebreast tissue satisfying pre-determined criteria.

The physical characteristic comprising a density of the breast tissuethat is determined by the image acquisition device based at least inpart upon the first image, the image acquisition device identifying atleast one imaging modality based at least in part upon comparing thedetermined breast density and a threshold density value.

The image acquisition device determining the density based at least inpart upon a physical description of the breast tissue comprising Vfg, Vband Vfg/Vb, wherein Vfg=a volume of fibroglandular the breast tissue,and Vb=a volume of the breast tissue.

The image acquisition device performing a lookup in a table to identifythe at least one imaging modality, wherein different imaging modalitiesare associated with respective density data in the table.

Modifying the at least one operating parameter further comprisingmodifying at least one exposure parameter, the at least one exposureparameter comprising at least one of an exposure window, an exposurevoltage or and an exposure number.

The motion parameter comprising at least one of a sweep angle and asweep speed of the image acquisition device.

The characteristic of the breast tissue comprising a density, athickness or a composition of the breast tissue.

The first image being generated by the image acquisition device emittinga first radiation dose that is substantially less than a radiation doseof the plurality x-rays used to generate respective projection images.

The first radiation dose is expressed as Df=Dp*1/(1+N), wherein Df=thefirst radiation dose; Dp=a total radiation dose of the plurality ofx-rays used to generate the plurality of projection images; and N=anumber of the plurality of projection images.

The first image is not a calibration image, and the first image and theplurality of projection images are images of the same breast tissue ofthe same patient.

The first image is not a calibration image, and the first image and theplurality of projection images are images acquired in real time duringthe same scan of the same breast tissue of the same patient.

The image acquisition device dynamically modifying the at least onemotion parameter in real time during the same scan of the same breasttissue of the same patient.

The image acquisition device automatically modifying the at least oneoperating parameter without input by a user of the image acquisitiondevice.

A computer-implemented method for acquiring a plurality of images ofbreast tissue during a scan of the breast tissue by an image acquisitiondevice, the method comprising: a computer-controlled image acquisitiondevice acquiring two dimensional projection image of the breast tissue;the image acquisition device processing the two dimensional projectionimage to determine a physical characteristic of the breast tissue; theimage acquisition device determining whether a plurality of threedimensional projection images of the breast issue should be acquiredbased at least in part upon the physical characteristic; and the imageacquisition device acquiring the plurality of three dimensionalprojection images if it is determined that the physical characteristicsatisfies pre-determined criteria.

The physical characteristic comprising a density of the breast tissue.

The image acquisition device determining the density based at least inpart upon a physical description of the breast tissue comprising Vfg, Vband Vfg/Vb, wherein Vfg=a volume of fibroglandular the breast tissue,and Vb=a volume of the breast tissue.

A method for acquiring a plurality of images of breast tissue during ascan of the breast tissue by an image acquisition device, the methodcomprising: a computer-controlled first image acquisition deviceacquiring a first image of the breast tissue using a first imagingmodality; the first image acquisition device processing the first imageto determine a physical characteristic of the breast tissue; the firstimage acquisition device determining that a plurality of projectionimages should be acquired using at least one of a second imagingmodality different than the first imaging modality, and a second imageacquisition device different than the first image acquisition device;and the first image acquisition device notifying an operator of thefirst image acquisition device that a plurality of additional imagesshould be acquired using at least one of the second imaging modality andthe second image acquisition device.

The operator being notified that the plurality of additional imagesshould be acquired using the second imaging modality and the first imageacquisition device.

The operator being notified that the plurality of additional imagesshould be acquired using the second imaging modality and the secondimage acquisition device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a system constructed according to oneembodiment and including a gantry and an acquisition workstation;

FIG. 2 is a flow diagram illustrating one embodiment of a method fordynamically modifying image acquisition parameters based on a physicalcharacteristic of an imaged object such as imaged breast tissue;

FIG. 3 illustrates a block diagram of system components or softwaremodules and data structures that may be used to implement embodimentsand that may be stored in a computer readable media of, utilized oraccessed by an acquisition workstation; and

FIG. 4 illustrates a conceptual diagram of a tomosynthesis imaging arcand a table of image acquisition parameters that may be determinedaccording to one or more measured characteristics of a breast as derivedfrom a scout image thereof according to one embodiment.

DETAILED DESCRIPTION OF ILLUSTRATED EMBODIMENTS

Systems, methods and computer program products embodied innon-transitory media for dynamically modifying an operating parameter ofan image acquisition device, such as a tomosynthesis breast imagingdevice, is described herein. The operating parameter in one embodimentan image acquisition parameter advantageously selected and derived ormodified in response to a measured characteristic of an imaged objectsuch as an imaged breast, and thus tailored to provide the highestquality image for the particular breast. For example, embodiments may beused to improve image quality in a breast tomosynthesis system bydynamically varying operating parameters of the tomosynthesis system inresponse to physical characteristics of the breast to be imaged(determined during image acquisition in real-time during a scan of thesame patient), such as the breast thickness or the breast density. Theability to dynamically vary acquisition or processing methods inreal-time during a patient scan helps to customize the system for eachparticular patient, thereby improving image quality and thus the abilityto identify and assess potential pathologies and abnormalities.

Parameters that may be varied in response to physical characteristicsmay include, but are not limited to, exposure parameters (includingnumber of acquired projection images, duration of exposure, voltage orcurrent used for exposure, etc.) and/or motion parameters (such as sweepangle, sweep speed, etc.). For example, existing tomosynthesis imagingsystems are designed to obtain a fixed number of projection images asthe x-ray source moves along a sweep angle (e.g., between −15 and +15degrees) over a predetermined time period which is based on an exposurewindow for each projection image. In existing systems such parametersare fixed, regardless of any differences in the physical characteristicsof the breast being imaged. According to certain embodiments, particularacquisition parameters related to certain physical characteristics ofthe imaged breast are dynamically modified in order to improve imagequality. For example, when imaging a large or very radiodense breast,the x-ray tube current mAs for each of the projections may need to belarge so as to adequately penetrate the breast. As the mAs areincreased, however, focal spot blurring caused by the longer exposurescan degrade image quality. One technique for mitigating the deleteriouseffects of large mAs and concomitant blurring is to reduce the scanspeed of the x-ray source. Alternatively, the number of projectionimages may be increased to assist in distinguishing architecturaldistortions.

Other embodiments are related to detecting possible object positioningerrors, e.g., detecting possible positioning errors of the same breastby analyzing different views of the same breast, or by analyzing imagesof different breasts. Further aspects of embodiments and otherembodiments and variations thereof are described in further detail withreference to FIGS. 1-4, which describe embodiments in which the objectbeing imaged is a breast of a patient.

FIG. 1 illustrates an embodiment of an image acquisition device orsystem in the form of a tomosynthesis acquisition system that isconfigured, programmed or adapted to modify at least one acquisitionparameter in response to breast density or thickness characteristics. Inthe illustrated embodiment, the system includes a gantry 100 and a dataacquisition work-station 102. Gantry 100 includes a housing 104supporting a tube arm assembly 106 rotatably mounted thereon to pivotabout a horizontal axis 402 and carrying an x-ray tube assembly 108.X-ray tube assembly 108 includes (1) an x-ray tube generating x-rayenergy in a selected range, such as 20-50 kV, at mAs such as in therange 3-400 mAs, with focal spots such as a nominal size 0.3 mm largespot and nominal size 0.1 mm small spot, (2) supports for multiplefilters such as molybdenum, rhodium, aluminum, copper, and tin filters,and (3) an adjustable collimation assembly selectively collimating thex-ray beam from the focal spot in a range such as from 7×8 cm to 24×29when measured at the image plane of an x-ray image receptor included inthe system, at a maximum source-image distance such as 75 cm. Alsomounted on housing 104, for rotation about the same axis 402, is acompression arm assembly 110 that comprises a compression plate 122 anda receptor housing 114 having an upper surface 116 serving as a breastplate and enclosing a detector subsystem system 117 comprising a flatpanel x-ray receptor, a retractable anti-scatter grid and a mechanismfor driving and retracting anti-scatter grid (not shown) as described inU.S. Pat. No. 7,443,949 entitled “Mammography system and methodemploying offset compression paddles, automatic collimation, andretractable anti-scatter grid” filed Oct. 17, 2002 by the assigneehereof, the contents of which are incorporated herein by reference.

Housing 104 also encloses a vertical travel assembly for moving tube armassembly 106 and compression arm assembly 110 up and down to accommodatea particular patient or imaging position and a tube arm assemblyrotation mechanism 406 to rotate tube arm assembly 106 about axis 402along different sweep angles to different imaging positions. A detectorsubsystem may include a rotation mechanism 408 for rotating componentsof detector subsystem 117 (such as x-ray receptor 502) about axis 402 toaccommodate different operations modes, and couple/uncouple mechanism410 to selectively couple or uncouple tube arm assembly 106 andcompression arm assembly 110 to and from each other, and tube armassembly 106 and detector subsystem 117 to and from each other. Housing104 also encloses suitable motors and electrical and mechanicalcomponents and connections to implement the functions discussed here.

Work-station 102 may comprise components similar to those in the SELENIAmammography system, including a display screen (typically a flat paneldisplay that may include touch-screen functionality), user interfacedevices such as a keyboard, possibly a touch-screen, and a mouse ortrackball, and various switches and indicator lights and/or displays.SELENIA is a registered trademark of Hologic Inc., Bedford, Mass.Work-station 102 may also include computer facilities similar to thoseof the SELENIA system (but adapted through hardware, firmware andsoftware differences) for controlling gantry 100 and for processing,storing and displaying tomosynthesis data received from gantry 100. Apower generation facility for x-ray tube assembly 108 may be included inhousing 104 or in work-station 102. A power source 118 powerswork-station 102. Gantry 100 and work-station 102 exchange data andcontrols over a schematically illustrated connection 120.

Additional storage facilities can be connected to work-station, such asone or more optical disc drives for storing information such aspreviously obtained images and software, or a local printer (not shown).In addition, the disclosed system can be connected to a hospital orlocal area or other network and through the network to other systemssuch as a soft copy workstation, a Computer Aided Detection (CAD)station, a technologist workstation and other imaging systems or outputdevices.

In standard mammography mode, typically used for screening mammography,tube arm assembly 106 and compression arm assembly 110 are coupled andlocked together in a relative position such as seen in FIG. 1, such thatan x-ray beam from x-ray tube assembly 108 illuminates x-ray receptorwhen the patient's breast is compressed by compression device 112. Inthis mode, the system operates in a manner similar to said SELENIAsystem to take a mammogram. A vertical travel assembly and tube armrotation mechanism can make vertical adjustments to accommodate apatient, and can rotate tube arm assembly 106 and compression armassembly 110 together as a unit about an axis for different imageorientations such as for CC and for MLO images. For example, tube armassembly 106 and compression arm assembly 110 can rotate between (−195degrees) and (+150 degrees) about the axis.

In tomosynthesis mode, tube arm assembly 106 and compression armassembly 110 are decoupled such that compression arm assembly 110 staysin one position, compressing the patient's breast, while tube armassembly 106 rotates about the axis, for example +/−15 degrees relativeto compression arm assembly 110. Tomosynthesis can be carried out fordifferent image orientations, so that compression arm assembly 110 canbe rotated about the axis (alone or together with assembly 106) for adesired image orientation and locked in place, and then tube armassembly 106 can be rotated relative to that position of compression armassembly 110 for tomosynthesis imaging over +/−15 degrees or some otherdesired angular range.

For example, as mentioned above according to one aspect, the angularrange of the tomosynthesis sweep can be varied according tocharacteristics of the imaged breast. In addition image exposureparameters including number of acquired projection images, duration ofexposure, voltage or current used for exposure can also be dynamicallyvaried in accordance with the particular composition of the imagedbreast.

While certain embodiments are described with reference to amammography/tomosynthesis system, it will be understood that embodimentsmay involve an image acquisition system that is capable of or thatutilizes other imaging modalities and combinations thereof. For example,while embodiments may be implemented using a combinationmammography/tomosynthesis machine, embodiments may also involve astand-alone tomosynthesis acquisition system or stand alone mammographysystem. Moreover, while certain embodiments are described with generalreference to x-ray and tomosynthesis imaging acquisition devices,embodiments may involve one or more and various combinations of handheldand robotic imaging modalities including 2D x-ray projection imaging,tomosynthesis x-ray projection imaging, 3D breast ultrasound,robotic-guidance targeted local 2D and 3D breast ultrasound, magneticresonance imaging, positron emission mammography, breast specific gammaimaging, and other imaging modalities in order to acquire images for usein embodiments. Further, as described in further detail below, varioustypes and combinations of imaging modalities may be utilized for imageacquisition, and embodiments may involve automatically acquiring imagesusing the same or one or more other modalities or recommending to atechnician or user that another imaging system or modality, which may bethe same or different than the imaging modality, should be utilized.Further, embodiments may involve an initial 3D projection image todetermine whether to proceed with additional 2D projection images or aninitial 2D projection image to determine whether to proceed withadditional 3D projection images. For ease of explanation, reference ismade to x-ray imaging, e.g., mammography and tomosynthesis, and to afirst or scout image that is a 2D projection image and subsequent 3Dprojection images as examples of how embodiments may be implemented.

Referring to FIG. 2, one embodiment of a process 200 for dynamicallysetting image acquisition parameters may be implemented or executed by acontroller, processor and/or computer of, utilized or accessed by theimage acquisition system or components thereof shown in FIG. 1. At step210 image acquisition parameters are initialized. In particular theacquisition parameters are set to those used to capture an AutomaticExposure Control (AEC) (or “scout”) image of the breast, where a firstor scout image (generally, “scout” image) is an x-ray is taken (eitherat a low dose, or full dose) and the image receptor's image is read by aprocessor or controller as part of a computer process.

At step 212, the breast is compressed and the scout image is obtained.The computer process uses information from the scout image to identifythe breast's radio-density and to calculate the optimal x-ray tubeexposure voltage kVp, current mAs, and exposure time for delivering adesired x-ray dose.

A variety of methods can be used to determine breast radio-density. Forexample, the overall density of the breast can be determined by findingthe mean density of the breast from the pixel values of the breast imageby adding all pixel values and dividing the result by the number ofpixel values. Other ways of deriving breast characteristics, includingdensity, from breast image are discussed by Highnam, Brady, andShepstone in “Mammographic Image Analysis”, Eur. J. Radiologic, 1997January; 24(1)20-32, incorporated herein by reference. Additionalmethods of determining breast density are described in U.S. PatentApplication U.S. 2007/0274585 and U.S. Pat. No. 5,657,362, each of whichis also incorporated herein by reference as through set forth in full.Alternative methods of determining breast thickness can also be used.Various methods take into account the distance between compressionpaddles and the force used to reach a desired compression.

With continuing reference to FIG. 2, at step 214, information associatedwith the identified mA and exposure time may be used to determine thepotential extent of focal spot blur. Should it be determined at step 216that the potential focal spot blur exceeds a desired threshold, at step218 at least one acquisition parameter is modified in response to thebreast density and/or breast thickness information to either reducefocal spot blur (for example, by increasing mA and reducing the exposurewindow), compensate for focal spot blur (for example by increasing thenumber of projection images for varying the sweep angle), or meet someother imaging goal (such as reducing exposure). At step 220 the image isthen acquired using the customized acquisition parameters. It can beappreciated that the selection of which acquisition parameter to vary tomeet a desired goal (and even the desired goal itself) is can be basedon analytical and/or empirical determinations in the design of thesystem for promoting an optimal balance of high image quality andreduced radiation dose, and may differ depending upon the particularbreast composition.

For example, for ‘fatty’ breast it may be more desirable to reduce mAand increase the exposure window, while for ‘dense’ breasts it is moredesirable to increase mA, reduce the exposure window and/or obtainadditional projection images. In one embodiment, a pre-populated lookuptable may be provided that outputs desired acquisition parameters basedon thickness and/or density information. This pre-populated lookup tablemay be stored in a computer storage medium, capable of being updated asdesired, for example based on a particular population or improved data.Alternatively, received density and/or thickness information may bedynamically processed using pre-programmed or dynamically programmedalgorithms for dynamic selection of acquisition parameters fortomosynthesis imaging. A person skilled in the art would be able torealize such lookup table, based on analytical and/or empirical data andother information known to the skilled artisan, without undueexperimentation in view of the present disclosure.

FIG. 3 illustrates several components that may be included in oneembodiment of a control system 300 for controlling the acquisition ofprojection images by a breast tomosynthesis system. Control system 300includes a plurality of components which may be implemented in hardware,software or a combination thereof. Control system 300 includesacquisition controller 310 which provides signals for controlling thex-ray tube, including information for controlling the number ofprojection images, sweep angle for the tube arm, exposure window, mA andvoltages of each exposure, and other motion and exposure parameters. Amemory, database or other storage device in control system 300 storesthe scout image 320, which is in one embodiment a 2D projection imagecomprising a plurality of pixels having intensities which represent thex-ray attenuation values at the various points in the image.Attenuation/density analysis unit or processor 330 includes, utilizes oraccesses a Look Up Table (LUT) 340 that may also be stored in memory,database or other storage device and analyzes attenuation informationfrom scout image 320 to determine a breast density using any of themethods described above. The attenuation/density analysis unit orprocessor 330 access or utilize the LUT 340 to receive as an input,read, determine or derive density information and/or breast thicknessinformation (for example, as received from the acquisition controller310 in response to compression plate relative distance and compressionforce) to provide breast tomosynthesis acquisition parameters forobtaining optimal tomosynthesis images for the particular breastcomposition.

Accordingly, a system and method for dynamically selecting oridentifying and modifying an image acquisition parameter for use intomosynthesis breast imaging provides in response to a measuredcharacteristic of an imaged breast allows for a tailored and customizedset of operating parameters, thus providing the highest quality imagefor the particular breast composition.

FIG. 4 illustrates a conceptual diagram of a tomosynthesis imaging arctraversed by the x-ray source of a tomosynthesis imaging system, and atable 420 of image acquisition parameters that may be determined (e.g.according to a LUT) according to one or more measured characteristicsderived from a scout image thereof according to a preferred embodiment.Shown in FIG. 4 is an x-ray point source 402 mounted on a gantry (notshown), the system being configured to acquire “N” tomosynthesisprojection images over a tomosynthesis imaging arc θ_(T) encompassing“N” respective angular locations 404. The tomosynthesis imaging arcθ_(T) is traversed in an overall gantry sweep time T. During thecontinuous angular sweep, the x-ray imaging source 402 is kept offexcept in an angular interval Δθ_(i) around each projection imaginglocation, where it is activated at a predetermined tube current (mA) andoperating voltage (kVp) for a time interval Δt_(i), termed an exposurewindow, resulting in a milliamp seconds metric (mAs_(i)) for eachprojection image and, for N projection images, an overall milliampseconds metric (mAs_(T)) of N times (mAs_(i)). The total radiation doseto the patient for the tomosynthesis imaging sweep is proportional tothe total milliamp seconds metric mAs_(T). As known in the art, thetotal radiation dose also increases as kVp increases. The amount offocal spot blurring is directly proportional to angular interval Δθ_(i),and so this arc, which is equal to the angular velocity of thegantry×exposure window, can be called a “blur angle” as denoted in FIG.4.

According to one embodiment, a scout image of the breast, as properlypositioned and compressed between compression paddles, is acquired bythe tomosynthesis imaging system with the x-ray source positioned eitherat zero degrees (i.e., in the middle of the imaging arc at a positioncorresponding to a standard 2D mammography projection image), or at apredetermined offset angle from zero degrees. The parameters for thescout image are configured such that the overall radiation dose isapproximately 1/(1+N) times the conventional 2D mammography projectionimage dose, where N is the nominal number of tomosynthesis projectionimages for an average-sized breast having average densitycharacteristics. By way of example, the tomosynthesis imaging system mayhave a nominal number of 15 projection images (N=15) that are taken overa nominal tomosynthesis imaging arc of 15 degrees, the x-ray sourcebeing rotated from −7.5 degrees to 7.5 degrees. As would be appreciatedby the skilled artisan in view of the present disclosure, the term“nominal” is used here because the system according to the presentinvention can operate at multiple different values for the number ofprojection images depending on the breast characteristics, but willgenerally have a default or starting configuration designed for theaverage expected breast characteristics. For purposes of example onlyand not by way of limitation, where a typical radiation dose for anaverage breast might be 1.6 mGy for standard 2D projection mammography,the dose for the scout image would be on the order of 0.1 mGy. Thus,according to one embodiment, the dose of the scout image issubstantially less than the dose of the plurality of projection imagesindividually and collectively. The dose of the scout image may besufficiently low such that a physical attribute of breast tissue imagedin a scout image can be analyzed by a processer, but is not readable ormeaningfully discernable by a user or technician of the imageacquisition system.

Upon acquisition, the scout image is then processed or analyzedaccording to one or more of the above-described methods, such as theHighnam & Brady method, to generate a two-dimensional array thatcharacterizes, for each pixel, the total columnar height offibroglandular tissue (in cm) for that pixel location (alternatively theheight can be expressed as a percentage of the paddle separationdistance. Thus, for example, where the compression paddles are separatedby 4 cm, the algorithm might compute, for one pixel location, afibroglandular tissue height of 1.4 cm, meaning that there is a total of1.4 cm of fibroglandular tissue and 2.6 cm of fat between thecompression paddles above that pixel location, and might compute, foranother pixel location, a fibroglandular tissue height of 0.7 cm,meaning that there is a total of 0.7 cm of fibroglandular tissue and 3.3cm of fat between the compression paddles for that other pixel location.This two-dimensional array can be called a “physical description image”or “physical description” of the breast.

For one preferred embodiment, the physical description image can beprocessed (based, for example, on known attenuation coefficients forfibroglandular tissue versus fat tissue) to determine a region (forexample, a region of a predetermined size such as a 1 cm-radius circle)for which there will be maximum average attenuation, and then theacquisition parameters can be determined based on that maximumattenuation region and value (using, for example, the lookup tablemethod described above). In an alternative preferred embodiment, theremay be computed overall breast volumetric density assessment metrics orother biomarker derived from the physical description of the breast (orsimilar breast density mapping algorithm), which is provided as an inputto a breast volumetric assessment software package or system such asQuantra™, which computes one or more such metrics and is available fromHologic Inc., Bedford, Mass. Further details regarding the Quantra™system are described in “Understanding R2 Quantra 1.3,” PN MAN-01224 Rev001, Hologic, Inc. (2009), the contents of which are incorporated hereinby reference.

For example, the Quantra™ breast volumetric assessment software packagemay compute and process the physical description of the breast togenerate a volume Vfg of fibroglandular tissue (in cubic centimeters orcm³), an overall volume Vb of the breast (in cm³), and then divides thevolumes to produce a volumetric fraction Vfg/Vb of breast fibroglandulartissue as a percentage of the overall breast volume. In yet anotherpreferred embodiment, the selection of the image acquisition parameterscan be based on a combination of regional density characteristics andthe overall breast assessment measures Vfg, Vb, and Vfg/Vb.

For purposes of example only and not by way of limitation, the LUT 340may be programmed with numerical information that results in thefollowing one or more scenarios. For a “nominal” breast having averageexpected statistical characteristics, the system may have a defaultconfiguration of a 15-degree tomosynthesis imaging arc (i.e., −7.5degrees to +7.5 degrees), with N=15 tomosynthesis projection images, anoverall gantry sweep time of 3 seconds, an exposure window of 100milliseconds, a tube current of 100 mA, and an operating voltage of 28kVp (for a 4 cm breast) or 29 kVp (for a 5 cm breast). For this nominalscenario, there is a blur angle of (0.1 sec)(15 degrees/3 sec)=0.5degrees. However, if the scout imaging process and associated densityevaluation indicates a very high breast density (with size and othercharacteristics staying the same), the lookup table might yield anoptimal configuration of a 20-degree tomosynthesis imaging arc (i.e.,−10 degrees to +10 degrees), with N=20 tomosynthesis projection images,and an overall gantry sweep time of 4 seconds, the other parametersstaying the same. For this scenario, there is advantageously the sameblur angle of (0.1 sec)(20 degrees/4 sec)=0.5 degrees, and yet there isa higher overall exposure, a higher number of images, and an increasedoverall arc provided for sufficiently imaging through the denser tissue.In other alternatives, there can be the same 15-degree sweep angle withN=30 images and the same sweep time of 3 seconds, the other parametersstaying the same. On the other hand, if the scout imaging process andassociated density evaluation indicates a very low breast density (withsize and other characteristics staying the same), the lookup table mightyield an optimal configuration of a 15-degree tomosynthesis imaging arc,with N=15 tomosynthesis projection images, an exposure window of 50 ms,and an overall gantry sweep time of 1.5 seconds, the other parametersstaying the same. For this scenario, there is the same blur angle, but amuch lower dose because that is all that is really needed for thelow-density breast. Alternatively or in conjunction the number ofprojection images can be reduced. It is to be appreciated that there aremany different trade-offs and alternative scenarios and sub-scenariosthat can be implemented into the lookup table 340 other than thesimplified example provided above while remaining well within the scopeof the present teachings.

In other embodiments, breast composition characteristics are considered,e.g., not only breast density as discussed above, but also breast tissueparenchymal pattern or distribution.

According to another embodiment, the overall breast assessment metricsare used to alert the radiology technician (or other medicalprofessional who is positioning the patient and operating the imageacquisition system) that they may have made a breast positioning error.Generally speaking, for the same physical breast, the breast assessmentmeasures Vfg, Vb, and Vfg/Vb should be similar between two differentviews. Thus, according to one embodiment, the breast assessment measuresVfg, Vb, and Vfg/Vb can be computed separately for two different viewsof the same breast (CC and MLO, for example) and then compared with eachother. If one or more of these metrics is substantially different forone view compared to the other view, e.g., for the CC view versus theMLO view (for example, greater than 15% difference between the views, orsome other threshold different), then this fact and/or an alert of apossible positioning error, is brought to the attention of thetechnician, because there may have been a positioning error in one orboth of the views. Predetermined weightings or expected offsets can beincluded in the comparison process as needed (for example, toaccommodate for the effects on the assessment metrics of the presence ofthe pectoral muscle in the MLO view versus the CC view, for example).Contralateral comparisons can also be used, since the volumetricassessment metrics for the left and right breasts can also be expectedto have some general correspondence.

Other embodiments may involve analysis of different breasts of the samepatients. For this purpose, the same view of each breast may be analyzedto determine a possible positioning error of at least breast, ordifferent views of each breast may be utilized. Similar to the methoddescribed above, if one or more of these metrics is substantiallydifferent for one breast compared to the other and/or for one viewcompared to the other view, then this fact and/or an alert of a possiblepositioning error, is brought to the attention of the technician,because there may have been a positioning error in one or both of theviews.

Having described various embodiments of the invention, it should beappreciated that the above specific examples and embodiments areillustrative, and many variations can be introduced on these examplesand embodiments without departing from the spirit of the disclosure orfrom the scope of the appended claims. For example, elements and/orfeatures of different illustrative embodiments may be combined with eachother and/or substituted for each other within the scope of thisdisclosure and appended claims. In addition, certain flow diagrams havebeen used to describe various processes, it should be appreciated thatthe processes can be performed in hardware, software, or a combinationthereof. The software may comprise a plurality of program code and datastructures which are stored in a computer readable medium local to orremote from the tomosynthesis image acquisition system, and maygenerally be used to transform the acquired scout image information intophysical control signals for controlling image capture.

Moreover, while certain embodiments are described above with referenceto a scout image and subsequent projection images acquired using atomosynthesis system, the system may involve an initial analysis of ascout image and whether additional projection images should be acquired,and if so, which imaging modalities and/or imaging systems should beutilized for acquiring additional images following the scout image.

For example, according to one embodiment, if by the scout image thebreast is found to be very low-density (below a certain threshold) andyet the clinic work order has called for tomosynthesis, the system canautomatically “prohibit” the tomosynthesis process from taking place,because it is not needed. Conversely, according to another embodiment,if by the scout image the breast is found to be very high-density (abovea certain threshold) and yet the clinic work order has not called fortomosynthesis, the system can automatically “strenuously recommend” oreven automatically initiate the tomosynthesis process or one or moreother imaging modalities because it is needed.

In another embodiment, a scout image may be acquired, and the system mayautomatically proceed to modify a motion parameter based on a physicalcharacteristic of the breast derived from the account and then acquireprojection images using the same imaging modality that was utilized toacquire the scout image. Thus, the scout and subsequent projectionimages can be acquired in real time during the scan of the same patient,while selected motion or other parameters are dynamically modified onthe fly during the scan, without requiring the user or technician tomanually adjust the motion or other operating parameters and/or manuallyconfirm or authorize acquisition of additional projection images. Inanother embodiment, additional projection images are acquired afterconfirmation by the technician or user.

According to another embodiment, a scout image may be acquired, and ifit is determined that additional images are to be acquired, the systemmay automatically proceed to acquire or recommend acquisition ofprojection images using the same imaging modality that was utilized toacquire the scout image. Thus, for example, the initial scout image andthe additional projection images can be acquired using the same systemand same tomosynthesis imaging modality. According to anotherembodiment, a scout image may be acquired using a first imagingmodality, and if it is determined that additional images are to beacquired, the system may automatically proceed to acquire projectionimages using another imaging modality determined or identified by thesystem. For this purpose, a controller or processor of the system mayaccess a lookup table (e.g., as discussed above with reference to FIG.3) that includes data of a physical characteristic such as breastdensity or other derived data or characteristics and correspondingimaging modalities such that one or more other imaging modalities may beidentified if the physical characteristic data satisfies pre-determinedcriteria, e.g., based at least in part upon a comparison of the breastdensity and a pre-determined or threshold density value.

For example, the first or scout image may be a 2D x-ray projectionimage, and the subsequent images are acquired, or recommended to beacquired, using one or more other imaging modalities such as 3D breastultrasound, robotic-guidance targeted local 2D and 3D breast ultrasound,magnetic resonance imaging, positron emission mammography, breastspecific gamma imaging, and other imaging modalities,

Thus, embodiments may involve a scout image such as a two-dimensionalprojection image followed by acquisition or a recommendation to acquirea plurality of other images such as three-dimensional projection imagesusing the same imaging modality and same image acquisition system, ascout image acquired using a first image modality and an imageacquisition system followed by a plurality of other images using anotherimaging modality and same image acquisition system, a scout imageacquired using a first image modality and a first image acquisitionsystem followed by a plurality of other images using another imagingmodality and different, second image acquisition system.

Further, although FIG. 3 illustrates several representative componentsof an acquisition parameter control system, it will readily beappreciated by one of skill in the art that any delineation were made ona functional basis solely for the purpose of simplifying description ofa representative embodiment. Moreover, it will be understood thatembodiments may be implemented or executed by system components such asa computer, controller, a processor that analyzes physicalcharacteristics such as density, and that such component may beintegrated within the system shown in FIG. 1 or accessed by the system.Thus alternative embodiments which include additional functionality, ordifferently delineated functionality, are to be considered equivalentshereto. Thus the present invention should not be limited by the abovedescription, but rather only by the appended claims.

Whereas many alterations and modifications of the present invention willno doubt become apparent to a person of ordinary skill in the art afterhaving read the foregoing description, it is to be understood that theparticular embodiments shown and described by way of illustration are inno way intended to be considered limiting.

For example, while certain embodiments have been described withreference to determining physical characteristic of the breast tissuesuch as one or more of thickness, density and composition based on aninitial 2D projection image to determine whether to acquire additional3D projection images, embodiments may also involve an initial 3Dprojection image to determine whether to acquire additional 2D images.It will also be understood that the initial image may be used to utilizeor recommend a single or multiple other imaging modalities or use of thesame or other image acquisition device.

As a further example, while certain embodiments have been described withreference to determining physical characteristic of the breast tissuesuch as one or more of thickness, density and composition fordetermining potential positioning errors, other embodiments may involvea comparison of a view from a present study with a view from a priorstudy (a temporal comparison). In such embodiments in which thecomparison is temporal, then the current value may be larger than theprior. In such cases, the positioning may be better that that of theprior such that more tissue is pulled into view onto a detector.However, if the value for the current is smaller than that of the prior,then the positioning may be worse such that less tissue is pulled ontothe detector.

Further, where methods and steps described above indicate certain eventsoccurring in certain order, those of ordinary skill in the art havingthe benefit of this disclosure would recognize that the ordering ofcertain steps may be modified and that such modifications are inaccordance with the variations of the invention. Additionally, certainof the steps may be performed concurrently in a parallel process as wellas performed sequentially. Thus, the methods shown in various flowdiagrams are not intended to be limited to a particular sequentialorder, unless otherwise stated (e.g., a scout image preceding otherimages) or required.

Accordingly, embodiments are intended to exemplify alternatives,modifications, and equivalents that may fall within the scope of theclaims.

What is claimed is:
 1. A method for detecting a possible patientpositioning error during x-ray breast image acquisition, the methodcomprising: positioning, under the control of a user of an imageacquisition device, a breast of a patient into a first compressedimaging position according to a first view of the image acquisitiondevice; acquiring a first mammographic image of the breast in the firstcompressed imaging position; positioning, under the control of the user,the breast into a second compressed imaging position according to asecond view of the image acquisition device; acquiring a secondmammographic image of the breast in the second compressed imagingposition; processing the first and second mammographic images tocompute, for each of the first and second mammographic images, at leastone breast volume assessment metric; comparing the at least one breastvolume assessment metric for the first mammographic image to the atleast one breast volume assessment metric for the second mammographicimage and, if the breast volume assessment metrics differ by more than athreshold amount, activating at least one user interface deviceassociated with the image acquisition device that alerts the user of apossible breast positioning error based at least in part upon thedifference.
 2. The method of claim 1, wherein the breast volumeassessment metric comprises at least one of a total breast volume (Vb),a fibroglandular tissue volume (Vfg), and a ratio (Vfg/Vb) offibroglandular tissue volume to total breast volume.
 3. The method ofclaim 1, wherein the first view is a craniocaudal (CC) view and thesecond view is a mediolateral oblique (MLO) view.
 4. The method of claim1, the first and second mammographic images being acquired by the imageacquisition device comprising an x-ray imaging apparatus.
 5. Acomputer-implemented for detecting a possible patient positioning errorduring x-ray breast image acquisition, the method comprising: acomputerized image acquisition device acquiring a first mammographicimage of a breast in a first compressed imaging position according to afirst view, wherein the breast was positioned by a user of the imageacquisition device into the first compressed imaging position accordingto the first view; the image acquisition device acquiring a secondmammographic image of the breast in a second compressed imaging positionaccording to a second view, wherein the breast was positioned by theuser into the second compressed imaging position according to the secondview; the image acquisition device processing the first and secondmammographic images to compute, for each of the first and secondmammographic images, at least one breast volume assessment metric; theimage acquisition device comparing the at least one breast volumeassessment metric for the first mammographic image to the at least onebreast volume assessment metric for the second mammographic image and,if the breast volume assessment metrics differ by more than a thresholdamount, activating at least one user interface device associated withthe image acquisition device that alerts the user of a possible breastpositioning error based at least in part upon the difference.
 6. Amethod for detecting a possible patient positioning error during x-raybreast image acquisition, the method comprising: positioning, under thecontrol of user of an image acquisition device, a first breast of apatient into a first compressed imaging position according to a firstview of the image acquisition device; acquiring a first mammographicimage of the first breast in the first compressed imaging position;positioning, under the control of the user, a second breast of thepatient into a second compressed imaging position according to a secondview of the image acquisition device, the second breast being oppositethe first breast; acquiring a second mammographic image of the secondbreast in the second compressed imaging position; processing the firstand second mammographic images to compute, for each of the first andsecond mammographic images, at least one breast volume assessmentmetric; comparing the at least one breast volume assessment metric forthe first mammographic image to the at least one breast volumeassessment metric for the second mammographic image and, if the breastvolume assessment metrics differ by more than a threshold amount,activating at least one user interface device associated with the imageacquisition device that alerts the user of a possible breast positioningerror based at least in part upon the difference.
 7. The method of claim6, wherein the breast volume assessment metric comprises at least one ofa total breast volume (Vb), a fibroglandular tissue volume (Vfg), and aratio (Vfg/Vb) of fibroglandular tissue volume to total breast volume.8. The method of claim 6, wherein the first view and the second view arethe same view of the first and second breasts.
 9. The method of claim 8,wherein the first view and the second view are a craniocaudal (CC) viewor a mediolateral oblique (MLO) view.
 10. The method of claim 6, whereinthe first view and the second view are different views of the first andsecond breasts.
 11. The method of claim 10, wherein the first view is acraniocaudal (CC) view, and the second view is a mediolateral oblique(MLO) view.
 12. The method of claim 6, the first and second mammographicimages being acquired by the image acquisition device comprising anx-ray imaging apparatus.
 13. A computer-implemented method for detectinga possible patient positioning error during x-ray breast imageacquisition, the method comprising: a computerized image acquisitiondevice acquiring a first mammographic image of a first breast in a firstcompressed imaging position, wherein the first breast was positioned bya user of the image acquisition device into the first compressed imagingposition according to a first view; the image acquisition deviceacquiring a second mammographic image of the second breast in a secondcompressed imaging position according to a second view, wherein thebreast was positioned by the user into the second compressed imagingposition according to the second view; the image acquisition deviceprocessing the first and second mammographic images to compute, for eachof the first and second mammographic images, at least one breast volumeassessment metric; the image acquisition device comparing the at leastone breast volume assessment metric for the first mammographic image tothe at least one breast volume assessment metric for the secondmammographic image and, if the breast volume assessment metrics differby more than a threshold amount, activating at least one user interfacedevice associated with the image acquisition device that alerts the userof a possible breast positioning error based at least in part upon thedifference.